Linking gastrointestinal issues to behaviour in autism

bowelThe presence of gastrointestinal (GI) issues appearing alongside autism in some people has seemingly emerged from the research shadows in recent years. Several well-powered studies have detailed the presence of issues with functional bowel symptoms such as diarrhoea and constipation to be more frequently reported in autism compared with both typically-developing children and those with learning disabilities not fulfilling the criteria for autism. This finding also spanning different samples of people in different geographical  locations.

Whilst issues remain about the implementation of management options available to tackle such bowel issues and improve quality of life (even relieving pain and discomfort in some cases), questions are continually being asked about the potential sources of such bowel problems. Further whether the presentation of functional bowel symptoms might show a relationship with some of the classical behavioural presentations that characterise autism; either one drives the other or both bi-directionally driving the presence of each other.

The paper by Peters and colleagues* approached this question, and specifically whether the presence of functional bowel issues may be associated with the presentation of rigid-compulsive behaviours noted in autism.

Based on an analysis of data from the Autism Treatment Network (ATN), a network of sites in the United States which offer medical care for those with autism, researchers were able to collect various information about participants enrolled at these sites and determine details on diagnosis and the presentation of additional symptoms including those related to functional bowel disturbances.

Researchers reported that nearly half of their cohort of participants overall (43%) were reported to show at least one bowel symptom. This finding is not dissimilar from other findings reported in this area. When examining those children / young adults who specifically presented with constipation plus diarrhoea or underwear staining vs. those where no bowel symptoms were reported present, researchers reported that those with bowel symptoms were more likely to have a parental report of repetitive or compulsive behaviour(s) or a specific diagnosis of obsessive-compulsive disorder (OCD).

This correlation also stretched to a greater likelihood of a family history of anxiety or OCD than those who were reported free of GI symptoms.

The authors draw upon other data hinting at a possible connection between bowel symptoms and the presentation of autism including a potential relationship with language regression and the presence of anxiety as evidence for the plausibility of a gut-brain connection in some cases of autism. Moreover they speculate whether treatment or management of said bowel issues may also have the ability to impact on elements of the behavioural presentation of autism (at least for some). Further investigation is required to test such assertions.


* Peters B. et al. Rigid-Compulsive Behaviors are Associated with Mixed Bowel Symptoms in Autism Spectrum Disorder. J Autism Dev Disord. 2013 Nov 29.

Further commentary on this study can be found at: